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Toxicology > Unit 1 - Decontamination of the Poisoned Patient > Flashcards

Unit 1 - Decontamination of the Poisoned Patient Flashcards

1
Q

What are the indications for ocular decontamination?

A

There was an irritant or corrosive chemical exposure: pH, key words on the bottle, if it causes burns to the skin

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2
Q

T/F: You should have owners start ocular decontamination at home

A

True

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3
Q

What are the best eye flushes to use for ocular decontamination?

A

Eye wash (best), tap water, and LRS or saline

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4
Q

What flush should be avoided for ocular decontamination?

A

Avoid eye drops

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5
Q

What does caution on a label signal/indicate?

A

Risk of significant illness/injury is low

Mild redness/irritation

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6
Q

What does danger on a label signal/indicate?

A

Risk of significant illness/injury is high

Alkaline pH of >11.5 or acid pH <2-3

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7
Q

If a label says the product is an ocular irritant, what may that mean for decontamination?

A

The owner may be able to perform it
Irrigation for 10-15 minutes
Monitor for signs of irritation
Symptomatic pets should be evaluated by DVM

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8
Q

What signs of irritation are associated with an ocular irritant?

A

Pawing or rubbing at the eye, redness, lacrimation, squinting, and swelling

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9
Q

If a label says the product is a corrosive, what may that mean for ocular decontamination and treatment?

A

The owner should attempt to irrigate at home for 15-20 minutes
Veterinarian should irrigate the eye for 15-20 minutes with eye wash
Fluorescein stain
Topical antibiotic ointment or drops
Elizabethan collar to prevent some trauma
Monitor for worsening signs

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10
Q

What are the indications for dermal decontamination?

A

Corrosives or irritants, systemically absorbed toxins, glues or adhesives, prevent oral exposure by self-grooming, remove unwanted substances, paresthesia, and burns

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11
Q

What decontamination methods should be used for a dermal irritant?

A

Rinse/bathe +/- topical vitamin E

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12
Q

What decontamination methods should be used for a dermal corrosive?

A

Rinse for 15 minutes, bathe with dish soap, and burn care

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13
Q

What are some systemic or orally absorbed toxins that can affect the dermis?

A

Tea tree oil, topical pain creams, estrogen creams, permethrin/pyrethrin (cats), psoriasis cream, and 5FU

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14
Q

How are systemic or orally absorbed toxins treated in cases of dermal contamination?

A

Bathe 2-3 times with a degreasing dish soap
Activated charcoal may be indicated
Blood work and supportive care will depend on the toxin type

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15
Q

How are glue/adhesive dermal contaminants decontaminated?

A

Loosen with oil, bathe, clip fur, and possible benign negligence

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16
Q

What is gasoline/hydrocarbons bad for the dermis?

A

Defatting the dermis, risk for aspirations, and Inhalation which causes CNS depression

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17
Q

How is dermal decontamination done for gasoline/hydrocarbons?

A

Bathe multiple times with degreasing dish soap and analgesics

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18
Q

What is the treatment for a first degree burn?

A

Lavage and topical therapy

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19
Q

What is the treatment for a second or third degree burn?

A

Debridement, silver sulfadiazine, analgesics, monitor for metabolic derangements

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20
Q

What are the indications for inhalation decontamination?

A

Concentrates or corrosives, smoke inhalation, and gas inhalation (chlorine, carbon monoxide, and natural

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21
Q

What is the decontamination method for a minor inhalation irritant?

A

fresh air

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22
Q

What does carbon monoxide do if inhaled?

A

Decrease the oxygen carrying capacity

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23
Q

What does thermal inhalation cause?

A

Edema, erosions, and ulcerations

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24
Q

What does inhalation of hydrogen cyanide cause?

A

cyanide toxicity

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25
Q

What is the treatment for inhalation toxicity in birds?

A

Remove from the source, humidified oxygen cage, heat support, and fluids

26
Q

What are the options for GI decontamination?

A

Emesis, gastric lavage, activated charcoal, cathartics, whole bowel irrigation, and/or endoscopy and surgical removal

27
Q

What are the indications for emesis?

A

Asymptomatic, foods, medications, large ingestions, rodenticides, small, dull foreign objects, and no breed or health risk

28
Q

What are the contraindications for emesis?

A

Symptomatic, already vomited bile, history or risks of aspiration pneumonia, sharp/dangerous objects, corrosive agent, or hydrocarbons

29
Q

What species do you want to avoid inducing emesis in?

A

rabbits, ruminants, horses, birds, and rodents (chincillas, rats, gerbils)

30
Q

The best content recovery with emesis is within ____ minutes.

A

30

31
Q

What toxicants are safe to induce emesis for up to 6 hours after ingestion?

A

Grapes/raisins, chocolate, gum, large plant ingestion, massive ingestion, and drugs that decrease gastric emptying

32
Q

What drugs decrease gastric emptying?

A

Opioids, salicylates, anticholinergics, and tricyclic antidepressants

33
Q

What can be used to induce emesis in dogs?

A

Apomorphine, hydrogen peroxide, and ropinirole (Clevor)

34
Q

What does apomorphine do?

A

Stimulates dopamine-2 receptors in CRTZ

35
Q

How can apomorphine be given?

A

IM, IV, and conjunctival administration

36
Q

How is Ropinirole (Clevor) given?

A

Drops in the eye

37
Q

What side effects are associated with Ropinirole (Clevor)?

A

Eye irritation, tachycardia, tachypnea, lethargy, ataxia, diarrhea, and tremors

38
Q

When should you use caution when administering Ropinerole?

A

When dogs have ocular and/or cardiac disease

39
Q

Ropinerole is not recommended for dogs that are what?

A

Pregnant or lactating

40
Q

What is a potential negative side effect of using hydrogen peroxide to induce emesis?

A

mucosal lesions in the stomach

41
Q

What can be used to induce emesis in cats?

A

Xylazine, dexmedetomidine, or hydromorphone

42
Q

What are the cons to using xylazine and dexmedetomidine to induce emesis in cats?

A

The efficacy isn’t great, excessive sedation, and cardiovascular collapse

43
Q

What are some inappropriate methods of inducing emesis?

A

Salt, syrup of ipecac, digital stimulation, and liquid dish soap

44
Q

What are the pros to using activated charcoal?

A

It is readily available and relatively inexpensive
It is suspected to bind to most toxicants
It may decrease absorption by 25-30%
It can be administered with food

45
Q

What are the cons to using activated charcoal?

A 
The window for administration is unclear
It can cause hypernatremia
It is difficult to administer
It is messy
It can cause vomiting after administration
It can cause diarrhea or changes to the stool
It binds to therapeutic medications
The benefit is unknown
46
Q

When is activated charcoal contraindicated?

A 
Neurologically inappropriate
Dehydration
Hypernatremia
Hypovolemic shock
Decreased GI motility/Ileus
Recent surgery
Protracted vomiting
Inappropriate timeframe
Ingestion of a caustic substance or hydrocarbon
Endoscopy
Abdominal surgery of the GIT
Gastric or intestinal obstruction
If there is a risk of aspiration pneumonia
47
Q

What is the most rapid and potent cathartic used for decontamination?

A

Sorbitol - it is often combined with charcoal

48
Q

What type of cathartic is sorbitol?

A

an osmotic cathartic

49
Q

How does sorbitol work?

A

It has hygroscopic action resulting in increased water in the large intestine and increased intraluminal pressure which stimulates catharsis

50
Q

What cathartic is useful for mild iron toxicity?

A

magnesium hydroxide

51
Q

What side effects are associated with magnesium based cathartics?

A

Hypotonia, ECG changes, altered mental status, and respiratory failure

52
Q

Why are magnesium based cathartics not recommended for bromethalin toxicity?

A

They may exacerbate or mimic toxicity signs

53
Q

When is gastric lavage indicated?

A

In species that do not vomit
If there was an unsuccessful emesis attempt
If there is a large volume of stomach content
In symptomatic patients with a large ingestion
Potentially life-threatening toxin

54
Q

What are the contraindications for gastric lavage?

A

Hydrocarbon ingestions, corrosives, recent surgery unstable patients, patients at higher risk for bleeding or injury, inappropriate time frame, or liquid toxins

55
Q

What is the method for gastric lavage?

A
  1. Sedate, intubate, and ET inflation
  2. Lateral recumbency with the head tilted down at an approximately 20 degree angle
  3. Measure tube to the last rib
  4. Flush 5-10ml/kg warm water through a large-bore stomach tube
  5. Agitate stomach
  6. Aspirate or gravity drainage of stomach contents
  7. +/- Activated charcoal
56
Q

What are the indications for whole bowel irrigation?

A

Iron intoxication, enteric coated drugs, sustained or ER formulations, and packets of drugs

57
Q

What agent is used for whole bowel irrigation?

A

polyethylene glycol

58
Q

When is endoscopy indicated?

A

For coins, non-leaking batteries, patches, bottles/plastic, other metals, and to evaluate for injury to the esophagus/stomach

59
Q

When is surgery indicated?

A

Gorilla glue, sharp objects, large foreign bodies, medication bezoars, leaking batteries, large # of objects, +/- bread dough

60
Q

What are the negatives to endoscopy or surgery decontamination?

A 
May be delayed pending stability of the patient
General anesthesia is required
Cost
Accessibility of equipment
Operator skill-endoscopy

Toxicology (32 decks)

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